FLORIDA INSURANCE 2-14 EXAM STUDY GUIDE 2025
QUESTIONS WITH ANSWERS GUARANTEE A+
✔✔There are three different approaches used by insurers in providing basic surgical
expense coverage and determining the benefits payable. Which of the following is NOT
one of these approaches?
-Reasonable and customary approach
-Physician schedule approach
-Relative value scale approach
-Surgical schedule approach - ✔✔Physician schedule approach
✔✔Charlie has a hospital expense policy and a surgical expense policy. The hospital
pays $100 a day for room and board and a maximum of $1,000 for miscellaneous
hospital charges. The surgical policy pays a maximum of $500 for any one operation. If
Charlie was hospitalized for 10 days and had charges of $200 per day for room and
board, $1,500 for miscellaneous expenses, and $2,000 for surgical expenses. What will
his policies pay of these expenses?
-$3,500
-$1,000
-$5,500
-$2,500 - ✔✔$2,500 (Explanation:
Hospital will pay - $1,000 for room and board ($100 per day for 10 days) and $1,000
(maximum allowed) for miscellaneous expenses. Surgical will pay - $500 (maximum
allowed) for surgery)
✔✔Once the insured has paid a specified amount of his expenses, under the stop-loss
feature of a health insurance policy, how much will the company then pay?
-75%
-20%
-80%
-100% - ✔✔100%
✔✔How will the "miscellaneous expenses" benefit be expressed in a basic health
insurance policy?
-Reasonable, usual and customary rates
-Multiple of daily room and board rate
-Approved charge per day rate
-Percentage of daily room and board rate - ✔✔Multiple of daily room and board rate
✔✔Roberta has a basic hospital expense policy with a $10,000 limit for benefits,
coordinated with a major medical policy with a $500 corridor deductible and 80/20
coinsurance provision. If she incurs a loss of $20,000, how much will the insurer pay?
-$17,600
-$18,000
-$11,900
,-$2,400 - ✔✔$17,600 (Explanation:
Total expenses are $20,000. Basic medical will pay the first $10,000 which leaves
$10,000 remaining. Roberta will pay the first $500 of this $10,000 with $9,500
remaining. Company will now pay 80% of $9,500 or $7,600. Total company pays will be
$10,000 from the basic medical plus $7,600 from the major medical = $17,600)
✔✔Which of the following statements is TRUE about basic hospital, medical and
surgical expense policies?
-The benefits provided are usually equal to the actual expenses incurred
-They contain high deductibles
-They usually have a stated limit for specific expenses
-Benefits are provided for loss of income - ✔✔They usually have a stated limit for
specific expenses
✔✔Which of the following types of insurance policies combines several types of benefits
and provides more coverage than any of the others?
-Hospital expense
-Comprehensive major medical
-Hospital indemnity
-Surgical expense - ✔✔Comprehensive major medical (Explanation:
Comprehensive major medical plans cover virtually all medical expenses in a single
policy. Such as hospital, physician and surgeon, nursing care, drugs, physical therapy,
x-rays, medical supplies, etc.)
✔✔Wanda has a Major Medical policy with a flat deductible of $250, coinsurance of
80%/20% and a stop-loss of $5,000. She has a covered claim for $5,500. What will
Wanda pay?
-$1,100
-$250
-$1,300
-$4,450 - ✔✔$1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the
remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total
amount of $1,300 ($250 deductible, plus 20% of 5,250).)
✔✔Travis has a Major Medical policy with a flat deductible of $500 and coinsurance of
80%/20% on the next $5,000 in covered expenses with 100% coverage for any
remaining covered expenses. On an claim of $10,000, what amount will Travis pay?
-$2,500
-$1,500
-$2,000
-$1,000 - ✔✔$1,500 (Explanation:
Travis will pay the first $500 (deductible) and then 20% of the next $5,000 ($5,000 x .20
= $1,000. So Travis will pay a total of $1,500 (deductible plus 20% of $5,000).)
,✔✔When comparing a major medical policy having an 80%/20% coinsurance provision
with one having a 75%/25% coinsurance provision, the insured will pay more or less
premium for the 80%/20% provision?
-Less premium
-The same premium
-Significantly less premium
-More premium - ✔✔More premium (Explanation:
Because the insured will be responsible for less of the cost for medical expenses (20%
verses 25%), he will pay more in premium costs.)
✔✔Jason has a Major Medical policy with a flat deductible of $500, coinsurance of
80%/20% and a stop-loss of $5,000. If he has a covered claim of $5,500, what will the
insurance company pay?
-$0
-$4,400
-$1,500
-$4,000 - ✔✔$4,000 (Explanation:
Jason will pay the first $500 (his deductible amount) of the total medical bills. After this
Jason will pay 20% of the remainder ($5,000) and the insurance company will pay 80%.
$5,000 (amount remaining) x .80 = $4,000 paid by insurance company.)
✔✔All of the following are types of major medical policy deductibles, EXCEPT?
-Franchise
-Integrated
-Corridor
-Flat - ✔✔Franchise
✔✔What type of medical expense policy simply provides a daily, weekly, or monthly
payment of a specified amount based on the number of days the insured is
hospitalized?
-Daily room and board expense policy
-Surgical expense policy
-Hospital Fixed-rate policy
-Hospital expense policy - ✔✔Hospital Fixed-rate policy
✔✔What type of medical expense policy would be available to cover the high costs
associated with a specific kind of illness such as cancer or heart disease?
-Hospital expense
-Surgical expense
-Major medical
-Limited risk - ✔✔Limited risk (Explanation:
Limited risk or dread disease policies are designed specifically to cover the high costs
associated with a specific illness.)
, ✔✔William was involved in a 2-car accident in which he is disabled and his passenger
and the driver of the other car are injured. Which of the following would most likely be
covered by William's disability income policy?
-Disability of the other driver
-His lost income
-William's medical expenses
-Dismemberment of the passenger's leg - ✔✔His lost income
✔✔Cathy is a dentist and decides to purchase insurance that would cover a large
portion of her income should she become disabled. What type of coverage will she
purchase?
-Disability income insurance
-Business overhead expense insurance
-Medical expense insurance
-Lump sum disability - ✔✔Disability income insurance
✔✔All of the following are true regarding a disability income policy defining total
disability as "own occupation", EXCEPT?
-Insured is unable to work at their own occupation as a result of an accident or sickness
-Difficult to qualify for
-More advantageous to the insurer
-More expensive than a policy providing "any occupation" - ✔✔More advantageous to
the insurer
✔✔Which of the following terms relates to payments made for partial disabilities?
-Residual amount
-Gross amount
-Net amount
-Recurrent amount - ✔✔Residual amount (Explanation:
The amount of benefit payable when a policy covers partial disabilities depends on
whether the policy stipulates a flat amount or a residual amount)
✔✔Daniel's disability income policy defines total disability as "the insured's inability to
perform the duties of any occupation for which he or she is reasonably qualified by
education, training or experience". This definition is known as?
-Own occupation and is less restrictive than other definitions
-Any occupation and is more restrictive than other definitions
-Any occupation and is less restrictive than other definitions
-Own occupation and is more restrictive than other definitions - ✔✔Any occupation and
is more restrictive than other definitions
✔✔Which of the following is NOT correct about partial disability?
-Benefit period is usually 3 to 6 months
-Flat amount benefit is usually 50% of the total disability benefit
-Proof of disability is not required for partial disabilities
QUESTIONS WITH ANSWERS GUARANTEE A+
✔✔There are three different approaches used by insurers in providing basic surgical
expense coverage and determining the benefits payable. Which of the following is NOT
one of these approaches?
-Reasonable and customary approach
-Physician schedule approach
-Relative value scale approach
-Surgical schedule approach - ✔✔Physician schedule approach
✔✔Charlie has a hospital expense policy and a surgical expense policy. The hospital
pays $100 a day for room and board and a maximum of $1,000 for miscellaneous
hospital charges. The surgical policy pays a maximum of $500 for any one operation. If
Charlie was hospitalized for 10 days and had charges of $200 per day for room and
board, $1,500 for miscellaneous expenses, and $2,000 for surgical expenses. What will
his policies pay of these expenses?
-$3,500
-$1,000
-$5,500
-$2,500 - ✔✔$2,500 (Explanation:
Hospital will pay - $1,000 for room and board ($100 per day for 10 days) and $1,000
(maximum allowed) for miscellaneous expenses. Surgical will pay - $500 (maximum
allowed) for surgery)
✔✔Once the insured has paid a specified amount of his expenses, under the stop-loss
feature of a health insurance policy, how much will the company then pay?
-75%
-20%
-80%
-100% - ✔✔100%
✔✔How will the "miscellaneous expenses" benefit be expressed in a basic health
insurance policy?
-Reasonable, usual and customary rates
-Multiple of daily room and board rate
-Approved charge per day rate
-Percentage of daily room and board rate - ✔✔Multiple of daily room and board rate
✔✔Roberta has a basic hospital expense policy with a $10,000 limit for benefits,
coordinated with a major medical policy with a $500 corridor deductible and 80/20
coinsurance provision. If she incurs a loss of $20,000, how much will the insurer pay?
-$17,600
-$18,000
-$11,900
,-$2,400 - ✔✔$17,600 (Explanation:
Total expenses are $20,000. Basic medical will pay the first $10,000 which leaves
$10,000 remaining. Roberta will pay the first $500 of this $10,000 with $9,500
remaining. Company will now pay 80% of $9,500 or $7,600. Total company pays will be
$10,000 from the basic medical plus $7,600 from the major medical = $17,600)
✔✔Which of the following statements is TRUE about basic hospital, medical and
surgical expense policies?
-The benefits provided are usually equal to the actual expenses incurred
-They contain high deductibles
-They usually have a stated limit for specific expenses
-Benefits are provided for loss of income - ✔✔They usually have a stated limit for
specific expenses
✔✔Which of the following types of insurance policies combines several types of benefits
and provides more coverage than any of the others?
-Hospital expense
-Comprehensive major medical
-Hospital indemnity
-Surgical expense - ✔✔Comprehensive major medical (Explanation:
Comprehensive major medical plans cover virtually all medical expenses in a single
policy. Such as hospital, physician and surgeon, nursing care, drugs, physical therapy,
x-rays, medical supplies, etc.)
✔✔Wanda has a Major Medical policy with a flat deductible of $250, coinsurance of
80%/20% and a stop-loss of $5,000. She has a covered claim for $5,500. What will
Wanda pay?
-$1,100
-$250
-$1,300
-$4,450 - ✔✔$1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the
remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total
amount of $1,300 ($250 deductible, plus 20% of 5,250).)
✔✔Travis has a Major Medical policy with a flat deductible of $500 and coinsurance of
80%/20% on the next $5,000 in covered expenses with 100% coverage for any
remaining covered expenses. On an claim of $10,000, what amount will Travis pay?
-$2,500
-$1,500
-$2,000
-$1,000 - ✔✔$1,500 (Explanation:
Travis will pay the first $500 (deductible) and then 20% of the next $5,000 ($5,000 x .20
= $1,000. So Travis will pay a total of $1,500 (deductible plus 20% of $5,000).)
,✔✔When comparing a major medical policy having an 80%/20% coinsurance provision
with one having a 75%/25% coinsurance provision, the insured will pay more or less
premium for the 80%/20% provision?
-Less premium
-The same premium
-Significantly less premium
-More premium - ✔✔More premium (Explanation:
Because the insured will be responsible for less of the cost for medical expenses (20%
verses 25%), he will pay more in premium costs.)
✔✔Jason has a Major Medical policy with a flat deductible of $500, coinsurance of
80%/20% and a stop-loss of $5,000. If he has a covered claim of $5,500, what will the
insurance company pay?
-$0
-$4,400
-$1,500
-$4,000 - ✔✔$4,000 (Explanation:
Jason will pay the first $500 (his deductible amount) of the total medical bills. After this
Jason will pay 20% of the remainder ($5,000) and the insurance company will pay 80%.
$5,000 (amount remaining) x .80 = $4,000 paid by insurance company.)
✔✔All of the following are types of major medical policy deductibles, EXCEPT?
-Franchise
-Integrated
-Corridor
-Flat - ✔✔Franchise
✔✔What type of medical expense policy simply provides a daily, weekly, or monthly
payment of a specified amount based on the number of days the insured is
hospitalized?
-Daily room and board expense policy
-Surgical expense policy
-Hospital Fixed-rate policy
-Hospital expense policy - ✔✔Hospital Fixed-rate policy
✔✔What type of medical expense policy would be available to cover the high costs
associated with a specific kind of illness such as cancer or heart disease?
-Hospital expense
-Surgical expense
-Major medical
-Limited risk - ✔✔Limited risk (Explanation:
Limited risk or dread disease policies are designed specifically to cover the high costs
associated with a specific illness.)
, ✔✔William was involved in a 2-car accident in which he is disabled and his passenger
and the driver of the other car are injured. Which of the following would most likely be
covered by William's disability income policy?
-Disability of the other driver
-His lost income
-William's medical expenses
-Dismemberment of the passenger's leg - ✔✔His lost income
✔✔Cathy is a dentist and decides to purchase insurance that would cover a large
portion of her income should she become disabled. What type of coverage will she
purchase?
-Disability income insurance
-Business overhead expense insurance
-Medical expense insurance
-Lump sum disability - ✔✔Disability income insurance
✔✔All of the following are true regarding a disability income policy defining total
disability as "own occupation", EXCEPT?
-Insured is unable to work at their own occupation as a result of an accident or sickness
-Difficult to qualify for
-More advantageous to the insurer
-More expensive than a policy providing "any occupation" - ✔✔More advantageous to
the insurer
✔✔Which of the following terms relates to payments made for partial disabilities?
-Residual amount
-Gross amount
-Net amount
-Recurrent amount - ✔✔Residual amount (Explanation:
The amount of benefit payable when a policy covers partial disabilities depends on
whether the policy stipulates a flat amount or a residual amount)
✔✔Daniel's disability income policy defines total disability as "the insured's inability to
perform the duties of any occupation for which he or she is reasonably qualified by
education, training or experience". This definition is known as?
-Own occupation and is less restrictive than other definitions
-Any occupation and is more restrictive than other definitions
-Any occupation and is less restrictive than other definitions
-Own occupation and is more restrictive than other definitions - ✔✔Any occupation and
is more restrictive than other definitions
✔✔Which of the following is NOT correct about partial disability?
-Benefit period is usually 3 to 6 months
-Flat amount benefit is usually 50% of the total disability benefit
-Proof of disability is not required for partial disabilities
